Surgical access assembly with sleeve and adjustable fastener

ABSTRACT

A surgical access assembly and method of use is disclosed, including an access member, a tissue engaging member, a sleeve extending from a portion of the membrane, and a fastening member to couple the access member and the sleeve. The access member includes proximal and distal ends, at least one lumen disposed therethrough, and defines a longitudinal axis. The tissue engaging member includes a membrane having proximal and distal ends with opposing openings, and a passage therethrough for receiving the access member. A length of the tissue engaging member may be selectively adjustable by a user so as to provide a retraction force. The sleeve extends proximally from a portion of the membrane. The sleeve has a proximal end and a distal end with opposing openings, the distal end of the sleeve defined by a portion of the membrane. A fastening member couples the access member and the sleeve.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/415,971, filed Mar. 9, 2012, which claims priority to, and thebenefit of, U.S. Provisional Patent Application Ser. No. 61/469,247,filed on Mar. 30, 2011, the entire contents of each of these priorapplications are incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to an access assembly for use inminimally invasive surgical procedures, such as endoscopic orlaparoscopic-type procedures, and more particularly to an accessassembly with an access member, a tissue engaging member, a sleeve, anda fastening member to couple the access member to the sleeve.

2. Background of Related Art

Today, many surgical procedures are performed through small incisions inthe skin, as compared to the larger incisions typically required intraditional procedures, in an effort to reduce both trauma to thepatient and recovery time. Generally, such procedures are referred to asendoscopic, unless performed on the patient's abdomen, in which case theprocedure is referred to as laparoscopic. Throughout the presentdisclosure, the term minimally invasive should be understood toencompass both endoscopic and laparoscopic procedures. During a typicalminimally invasive procedure, surgical objects, such as surgical accessmembers (e.g., trocar and/or cannula assemblies), endoscopes, or otherinstruments, are inserted into the patient's body through the incisionin tissue. Prior to the introduction of the surgical object into thepatient's body, insufflation gases may be used to enlarge the areasurrounding the target surgical site to create a larger, more accessiblework area. Accordingly, the maintenance of a substantially fluid-tightseal is desirable so as to minimize the escape of insufflation gases andthe deflation or collapse of the enlarged surgical site.

To this end, various access members are used during the course ofminimally invasive procedures and are widely known in the art. Acontinuing need exists for access members that can be inserted into avariety of tissue incision sites and be secured in place to maintain theconditions of the insufflated surgical site. It is further desirable toaccommodate a variety of tissue incisions and body surface conditions,and adapt to changing conditions at the surgery site, all whileprotecting the tissue surrounding a surgical site from damage.

SUMMARY

In accordance with various embodiments, the present disclosure isdirected toward a surgical access assembly with an access member, atissue engaging member, a sleeve to receive the access member, and afastening member to couple the access member and sleeve.

The access member has a generally hourglass profile with proximal anddistal ends, at least one lumen extending therethrough, and defines alongitudinal axis. The proximal and distal ends of the access member mayinclude flanges to aid in securing the access member in a layer oftissue.

The tissue engaging member is disposed around the perimeter of asurgical site. The tissue engaging member includes a membrane having aproximal end and a distal end. The proximal and distal ends of themembrane engage a body surface and an internal tissue wall,respectively. The proximal end of the membrane is defined by a resilientring having an arcuate or kidney bean shaped profile. A length of thetissue engaging member may be selectively adjustable by a user so as toprovide a retraction force, e.g., so as to retract an incision.

Attached to, and extending around, an outer circumference of the distalring is a sleeve that extends proximally through a passage defined bythe tissue engaging member. The sleeve has opposing openings and apassage therethrough for receiving the access member. The sleeve forms asubstantially fluid-tight seal with the access member. The sleeve isconfigured to move relative to the tissue engaging member. The sleevemay thus be inserted into the tissue engaging member with the accessmember disposed therein. In alternative embodiments, the sleeve may beattached to a portion of the distal ring, or may be attached to the ringitself. The sleeve may contain a protruding pocket on its outercircumference that receives a fastening member.

The fastening member circumferentially engages and couples the accessmember and the sleeve. The fastening member may be tightened around theaccess member and sleeve to provide a more secure coupling. Thefastening member may be a band having a grooved surface, and furtherincluding a receiving member to receive the grooved surface after thefastening member is disposed around the sleeve and access member. Thereceiving member may further include a pawl to avoid undesired backingout of the band from the receiving member. In embodiments, the fasteningmember may be a band having spaced protrusions along its length, with areceiving member having an aperture or channel to securely receive thespaced protrusions. In other embodiments, the fastening member may beformed of separable members, each having a protrusion connected to asecond protrusion having an aperture.

Also disclosed is a method of placing the surgical access assembly in alayer of tissue. An operator will dispose the proximal ring and theproximal end of the membrane proximally above the distal end of themembrane, and insert the distal ring into place at the distal end of themembrane. The operator will then insert the tissue engaging member intoa tissue site and extend the sleeve above a body surface. The tissueengaging member may be rolled about the proximal end of the membrane toshorten its length. Rolling the proximal end of the membrane about theproximal ring also shortens the length of the sleeve to a desiredlength. Alternatively, an excess length of the sleeve may be removed bythe operator. The operator then inserts an access member into the sleeveextending proximally from a portion of the membrane. The access memberis then securely coupled to the sleeve through the use of an adjustablefastening member. The operator inserts the fastening member into apocket formed on the outer circumference of the sleeve and adjusts thefastening member such that a desired compressive force is producedthereby forming a substantially fluid-tight seal.

Once the access member and the sleeve are securely coupled, the sleeveand access member are inserted into the tissue engaging member.Alternatively, the access member, sleeve, and tissue engaging member maybe inserted into a layer of tissue in conjunction with each other.Excess sleeve material extending proximally above the access member andmay be removed prior to use of the surgical access assembly. Surgicalinstruments may then be inserted through the access member and minimallyinvasive procedures can be performed.

The various aspects of this disclosure will be more readily understoodfrom the following detailed description when read in conjunction withthe appended drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Various exemplary embodiments of the present disclosure are describedherein below with reference to the drawings, wherein:

FIG. 1 is a side perspective view of the components of a surgical accessassembly, including an access member, a tissue engaging member, asleeve, and a fastening member;

FIG. 2 is a side perspective view of the surgical access assembly ofFIG. 1 without the access member as it appears as the tissue engagingmember and sleeve are formed about a pair of rings;

FIG. 3 is a side perspective view of the surgical access assembly asshown in FIG. 2 as it appears before insertion into a layer of tissue;

FIG. 4 is a cross-sectional view of the surgical access assembly asshown in FIG. 3 taken along section line 4-4;

FIG. 5 is a side cross-sectional view of the surgical access assembly asshown in FIG. 4 as it is inserted into a layer of tissue;

FIG. 6 is a cross-sectional view of the surgical access assembly asshown in FIG. 5 as an excess length of the sleeve is pulled away fromthe layer of tissue;

FIG. 7 is a side profile view of the surgical access assembly as shownin FIG. 6, as the excess length is rolled about a proximal ring by anoperator;

FIG. 8 is a side cross-sectional view of the surgical access assembly asshown in FIG. 7 as a surgical access member with a surgical instrumentdisposed therethrough is inserted into the sleeve;

FIG. 9 is a side perspective view of a fastening member having a bandand a receiving member;

FIG. 10 is an enlarged detail view of the receiving member and a portionof the band;

FIG. 11 is an exploded view of the receiving member and band as shown inFIG. 10;

FIG. 12 is a cross-sectional view of the fastening member taken alongsection line 12-12 as shown in FIG. 10, with the band inserted into thereceiving member;

FIG. 13 is an enlarged detail view of the cross-section of the receivingmember shown in FIG. 12;

FIG. 14 is a cross-sectional view of the receiving member as shown inFIG. 13 taken along section line 14-14;

FIG. 15 is a side cross-sectional view of the receiving member as shownin FIG. 13, with the band being disengaged from the receiving member;

FIG. 16 is a cross-sectional view of the surgical access assembly asshown in FIG. 8, without a surgical instrument, with an excess length ofthe sleeve prepared to be removed;

FIG. 17 is an embodiment of a fastening member having spaced protrusionsalong its length;

FIG. 18 is an embodiment of a fastening member having separable members.

FIG. 19 is an embodiment of a sleeve with a distal end attached to aportion of a tissue engaging member; and

FIG. 20 is an embodiment of a sleeve with a distal end attached directlyto a distal ring.

DETAILED DESCRIPTION OF EMBODIMENTS

The present disclosure will now describe in detail embodiments of asurgical access assembly with reference to the drawings in which likereference numerals designate identical or substantially similar parts ineach view. Throughout the description, the term “proximal” will refer tothe portion of the assembly closest to the operator, whereas the term“distal” will refer to the portion of the assembly farthest from theoperator. Although discussed in terms of an incision for a minimallyinvasive procedure, the presently disclosed surgical access assembly maybe used in any naturally occurring orifice (e.g. mouth, anus, orvagina).

Referring initially to FIG. 1, the components of a surgical accessassembly 100 are shown prior to assembly. The surgical access assembly100 includes an access member 110 having a generally hourglass shape, aproximal end 110 a and a distal end 110 b (FIG. 8), and defines alongitudinal axis A1 (FIG. 8). The proximal end 110 a and the distal end110 b of the access member 110 are substantially perpendicular to thelongitudinal axis A1. A flange 112 a defines the proximal end 110 a ofthe access member 110 and a flange 112 b defines the distal end 110 b ofthe surgical access member 110. The flanges 112 a,b may serve to anchorthe surgical access assembly 100 into a layer of tissue 500 (FIG. 5) orto another object. Access member 110 may be formed of a compressibleelement suitable for contact with internal body surfaces, such as foam.

Extending through the access member 110 along the longitudinal axis A1is at least one lumen 120, and in embodiments, multiple lumens 120. Thelumens 120 have entrance apertures 120 a and exit apertures 120 b (FIG.8) disposed in the proximal end 110 a and distal end 110 b of the accessmember 110, respectively. The lumens 120 are disposed substantiallyparallel to the longitudinal axis A1. Lumens 120 provide a path forobjects such as surgical instruments 600 (FIG. 8) to be inserted throughthe surgical access assembly 100. Lumens 120 may also provide a path forinsufflation fluids to be introduced to an internal body cavity 500 b(FIG. 5) below a layer of tissue 500. An access member of the typegenerally described above is disclosed in U.S. Patent ApplicationPublication Nos. 2009/0093752 A1 and 2010/0240960 A1, the entiredisclosures of which are incorporated by reference herein.

Referring for the moment to FIG. 4, a tissue engaging member 130includes a membrane 132 having a proximal end 132 a and a distal end 132b. Tissue engaging member 130 is configured to be disposed around theperimeter of a layer of tissue 500 that defines a surgical site. Tissueengaging member 130 covers a portion of a body surface 500 a (FIG. 5),extends into a tissue layer 500, and onto an internal tissue wall 500 c(FIG. 5). Distal end 132 b of membrane 132 contains a ring 134 b thatcontacts an internal tissue wall 500 c upon insertion into a layer oftissue 500. The ring 134 b at the distal end 132 b of membrane 132 is aresilient element over which membrane 132 is disposed. Proximal end 132a of membrane 132 is also defined by a ring 134 a and contacts bodysurface 500 a. Ring 134 a is generally a resilient member having anarcuate or kidney bean shaped profile. Other cross-sectional profilesare contemplated for the resilient ring at the proximal end 132 a of themembrane 132. The ring 134 a and proximal end 132 a of the membrane 132are generally attached such that the ring 134 a is not separable fromthe proximal end 132 a of the membrane 132. Such attachment may beaccomplished by, for example, stitching or fusion by heating.

Tissue engaging member 130 protects tissue layer 500 from damage causedby frictional engagement, shifting during operation, or other harmfulforces caused during minimally invasive procedures. As such, tissueengaging member 130 is formed of a material suitable for prolongedcontact with internal body surfaces.

The membrane 132 is disposed over the outer surface of the ring 134 b atthe distal end 132 b of the membrane 132, extends proximally through thepassage defined by the tissue engaging member 130 and defines a sleeve140. Sleeve 140 extends proximally from the tissue engaging member 130,and has a proximal end 140 a and a distal end 140 b. Thus, the distalend 132 b of membrane 132 is defined by the outside circumference ofring 134 b, and the distal end 140 b of sleeve 140 is defined by theinner circumference of ring 134 b. Proximal and distal ends 140 a, b ofthe sleeve 140 define opposing openings and a passage through the sleeve140 that is configured to receive the access member 110.

Referring for the moment to FIGS. 19-20, an alternative embodiment of asleeve member, designated 440, is shown. Sleeve 440 is substantiallysimilar to sleeve 140 described above, however, sleeve 440 is not formedof a continuous length of material with a membrane and looped aroundring 134 b. Rather, a distal end 440 b of sleeve 440 is attached to aportion of membrane 432. Similarly, a distal end 432 b of membrane 432of a tissue engaging member 430 is attached directly to the ring 134 b.Such attachment is accomplished by, for example, heat sealing orwelding, stitching, or adhesion. Distal end 440 b of sleeve 440 isdefined by a portion of membrane 432, and the attachment of the distalend 440 b of sleeve 440 and membrane 132 is accomplished as describedabove.

It is further contemplated that distal end of sleeve 440 may be attachedto ring 134 b in the manner described above, as shown in FIG. 20.

Turning for the moment to FIG. 8, upon receipt of the access member 110,the inner surface of sleeve 140 forms a substantially fluid-tight sealwith the outer surface of access member 110. The outer surface of accessmember 110 and the inner surface of sleeve 140 may frictionally engage,or a lubricous surface treatment may be provided to ease insertion. Thesubstantially fluid-tight seal between access member 110 and sleeve 140inhibits the escape of insufflation fluids from an internal body cavity500 b below a layer of tissue 500 or the passage of fluids between theexterior and interior of the opening in tissue. As such, access membersof various sizes and configurations may be inserted into a surgicalsite, and engagement with the sleeve 140 will ensure that an insufflatedworkspace is maintained in an internal body cavity below. Thus, surgicalaccess assembly 100 allows for the use of an access member of auniversal size to be used in a layer of tissue while minimizing the lossof insufflation fluid.

Sleeve 140 is configured for movement relative to the tissue engagingmember 130. Once access member 110 is inserted into the sleeve 140, thecoupled access member 110 and sleeve 140 may be translated distallyalong a portion of membrane 132 to a desired positioning within a layerof tissue 500.

Sleeve 140 may include in its outer circumference a pocket 142. Pocket142 is a portion of sleeve 140 that protrudes from the surface of sleeve140 and extends partially or entirely around the outer circumference ofsleeve 140. Pocket 142 contains a channel formed by the outer wall ofpocket 142 and the outer surface of sleeve 140. Pocket 142 may be slackrelative to the rest of sleeve 140, and has at least one aperture 142 a(FIG. 1) to receive and release a fastening member 150, such that afastening member 150 may circumferentially engage and couple sleeve 140and the access member 110 disposed therethrough.

Referring now to FIGS. 9-15, the fastening member 150 will be discussedin detail. As shown in FIG. 9, fastening member 150 includes a band 152that has a length sufficient circumscribing an outer circumference ofaccess member 110 and sleeve 140. Grooved surface 152 a is formed of aseries of ridges 152 a ₁ that are disposed at an angle with the surfaceof band 152. Fastening member 150 also includes a receiving member 154that receives and secures band 152 in a desired position.

As shown in FIG. 10, a portion of the receiving member 154 is fixablyattached to an end of the band 152. Also shown is a release 154 b, whichgives an operator control over the engagement of the receiving member154 and the band 152, as will be discussed further below.

Turning to FIG. 11, the receiving member 154 includes a top frame 154 a₁, to which the release 154 b is attached, and a bottom frame 154 a ₂.The release is coupled to a pawl 154 c, which is a rigid member having afirst end 154 c ₁ attached to the release 154 b, and a second end 154 c₂ that has a wedge shaped profile that engages the surface of the band152. The first end 154 c ₁ of the pawl 154 c may be attached to therelease in a pin-and-slot configuration as shown, or by any othersuitable method of attachment.

Referring to FIG. 12, the engagement of the band 152 and the receivingmember 154 is shown. The receiving member 154, when fully assembled,defines a channel 154 d through which band 152 translates. The band 152forms a loop upon insertion to the receiving member 154. As seen earlierin FIGS. 1-3, this loop circumferentially engages the access member 110and sleeve 140 when the fastening member 150 is disposed in the pocket154.

Turning to FIG. 13, grooved surface 152 a is defined by a series ofledges and spaces formed by the angled ridges 152 a ₁. The angle atwhich pawl 152 c is disposed causes second end 154 c ₂ of the pawl 152 cto slide over the ridges angled ridges 152 a ₁ as the band 152 istranslated through the channel 154 d. Additionally, receiving member 154includes a first or forward stop 155 and a second or back stop 157.First stop 155 limits the travel of pawl 154 c in a first direction suchthat second end 154 c ₂ of pawl 154 c seats in the notch of band 152.Second stop 157 limits the travel of pawl 154 c in a second, oppositedirection.

If band 152 is subject to forces that tend to translate the band 152 outof the receiving member 154, pawl 154 c interferes with the ridges 152 a₁ as it is biased toward a space in between the ridges 152 a ₁. The pawl154 c thus inhibits motion of the band 152 out of the receiving member154. Thus, fastening member 150 may be secured and tightened around theaccess member 110 and the sleeve 140, but the band 152 may not slip outof the channel 154 d without the intervention of an operator.

As the ridges 152 a ₁ are disposed at an angle, the pawl 154 c slidesover each ridge 152 a, to the apex of each ridge 152 a ₁, and then isforced into the space between ridges 152 a ₁ under a biasing force. Thisengagement of the pawl 154 c and the grooved surface 152 a (FIG. 9) iscontinuously repeated for the length of band 152 a. As shown in thefront view through the channel 154 d of FIG. 14, the band 152 is free totranslate through the channel 154 d without interference.

Referring to FIG. 15, disengagement of the band 152 from the receivingmember 154 is shown. In the event that it is desired that the fasteningmember 150 be loosened, the release 154 b may be engaged by theoperator. As the release 154 b is forced away from the channel 154 d bythe operator, the biasing force on the pawl 154 c is overcome and thepawl 154 c is moved away from the band 152 as it is disposed in thechannel 154 d. Without interference from the pawl 154 c, the band 152 isfree to translate into or out of the receiving member 154.

Referring for the moment to FIG. 17, a fastening member 250 is shown.Fastening member 250 includes a band 252 that has a length sufficientfor circumscribing an outer circumference of access member 110 andsleeve 140. Like fastening member 150 described above, fastening member250 is to be disposed in the pocket 142 around the circumference ofsleeve 140.

Band 252 includes spaced protrusions 252 a. Protrusions 252 a may bebeads, as shown, or may any other desirable shape. Protrusions 252 a areinterconnected by a connecting member 252 b, and are disposed at pointsalong the band 252 that have spaces 252 c between them. Protrusions 252a may be spaced at regular intervals with spaces 252 c of equal length,or may be disposed at varied intervals as desired.

Fastening member 250 also includes a receiving member 254 having anaperture 254 a that receives band 252. Aperture 254 a may securelyengage a protrusion 252 a, or may be configured to engage a connectingmember 252 b and space 252 c between protrusions 252 a.

Turning to FIG. 18, in another embodiment, a fastening member 350 isformed of separable members 352 having at least a first protrusion 352 aand a connecting member 352 b disposed through a space 352 c betweenprotrusions 352 a. A receiving protrusion 354 has an aperture 354 a tosecurely engage protrusion 352 a. Thus, a successive first protrusion352 a in a series of separable members may be inserted into aperture 354a, forming fastening member 350. As with fastening members 150 and 250as described above, fastening member 350 may be disposed in the pocket142 around the circumference of access member 110 and sleeve 140.

Referring back to FIG. 1, the tissue engaging member 130 and sleeve 140are shown fully disassembled and unrolled. The tissue engaging member140 is inverted before insertion into a layer of tissue 500, with thedistal end 132 b of the membrane 132 located proximally of the proximalend 132 b of the membrane 132. The fastening member 150 may be disposedthrough the pocket 142, or may be inserted later. The ring 134 b to belocated at the distal end 132 b of the membrane 132 is slid over theproximal end 140 a of the sleeve 140 to a desired length where thedistal end 132 b of the membrane 132 and the distal end 140 b of thesleeve 140 will be formed.

Turning now to FIG. 2, the tissue engaging member 130 and sleeve 140 areshown as they are prepared to be inserted into a layer of tissue 500(FIG. 3). The proximal end 132 a of membrane 132, attached to ring 134a, is raised proximally of and outside the ring 134 a. A cuff 136 isformed between the proximal ring 134 a and the point at which themembrane 132 is inverted. Distal ring 134 b is disposed at a point alongthe cuff 136.

Referring to FIG. 3, the ring 134 b is slid distally through the cuff136 and defines the distal end 132 b of the membrane 132, and the distalend 140 b of the sleeve 140, at its final resting position. With thering 134 b in place, the tissue engaging member 130 and the sleeve 140are fully defined as they are to be disposed in a layer of tissue 500.

Turning now to FIG. 5, the distal ring 134 b is compressed and deformedso as to fit through a layer of tissue 500. As such, distal ring 134 bis formed of a material that is resilient, but flexible enough so as tobe substantially deformed upon insertion into a layer of tissue 500,such as rubber or foam. When the distal ring 134 b has passed through alayer of tissue 500, the distal ring will revert to its original annularshape. Sleeve 140 and proximal ring 134 a remain disposed proximallyabove the layer of tissue 500.

Referring to FIG. 6, the tissue engaging member 130 and sleeve 140 areshown disposed in the layer of tissue 500. An operator adjusts thetissue engaging member 130 and the sleeve 140 to adapt to the particularneeds of the surgical site. As the proximal end 132 a of the membrane132 is translated proximally above the layer of tissue 500, materialfrom the sleeve 140 slides under the ring 134 b. Thus, the operator canchange the length of the sleeve 140.

Turning now to FIG. 7, the ring 134 a is shown as it is rolled by anoperator. Excess membrane 132 and sleeve 140 material is rolled over thering 134 a, and the ring 134 a is rolled toward the body surface 500 a.As compared to a ring with a circular profile, the arcuate or kidneybean shaped profile of the ring 134 a inhibits unrolling of the materialdisposed over the ring 134 a by providing a flattened edge disposed overbody surface 500 a that counteracts moments about the ring 134 a.

In the alternative embodiment of sleeve 440 described above, rolling thering 134 a causes the length of tissue engaging member 130 to shorten,but does not change the length of sleeve 440.

Referring for the moment to FIG. 16, it is further contemplated that anexcess length of sleeve 140 extending proximally above the access member110 may be removed by an operator. Constraints imposed by the nature ofthe surgical site or the nature of the procedure may make it preferableto excise an excess length of sleeve 140 rather than taking up slack byrolling the ring 134 a as described above.

Turning to FIG. 8, with the tissue engaging member 130 disposed in alayer of tissue 500, the access member 110 is inserted into sleeve 140.To aid in maintaining the substantially fluid-tight seal formed betweenthe access member 110 and the sleeve 140, the band 152 of the fasteningmember 150 is inserted into the receiving member 154 (FIG. 9). Theengagement of the grooved surface 152 a (FIG. 9) with the receivingmember 154 allows an operator control over the compressive force exertedaround the access member 110 and sleeve 140. Fastening member 150 may betightened to a desired degree, and ensures that the sleeve 140 will notmove independently of the access member 110.

The access member 110, disposed within the sleeve 140, may then beinserted into the layer of tissue 500. As the access member 110 andsleeve 140 are inserted distally along the longitudinal axis, the outersurface of sleeve 140 is in contact with the membrane 132. Sufficientlength of the sleeve 140 must be present distally of the access member110 such that the sleeve 140 is not rolled or slid away from the accessmember 110 as the access member 110 and the sleeve 140 are translateddistally into a layer of tissue. Sleeve 140 and membrane 132 mayfrictionally engage, or may be provided with a lubricous surfacetreatment so as to ease insertion into the layer of tissue 500.

With the surgical access assembly 100 secured in the layer of tissue500, one or more surgical instruments 600 can be inserted through thelumens 120 of the access member 110. Lumens 120 provide an unobstructedpath from points proximal of the surgical access assembly 100 to aninternal body cavity 500 b below the layer of tissue 500. Thus, anoperator can control a surgical instrument 600 to perform minimallyinvasive procedures in an internal body cavity 500 b.

Alternatively, the proximal ring 134 a may be further rolled such thatthe sleeve 140 is shortened until the access member 110 and sleeve 140are disposed in the layer of tissue 500. With the access member 110secured to the layer of tissue 500 with the flanges 112 a,b at theproximal 110 a and distal ends 110 b of the access member 110,additional rolling of the ring 134 a may retract a layer of tissue 500and widen a surgical site.

In this way, access members of various sizes may be utilized through anincision in tissue or naturally occurring orifice which has a largerdiameter than the surgical access member. It is contemplated that thesurgical access member may be inserted before, during or after thesleeve has already been positioned within an incision. Also, the size ofthe openings through any of the sleeves may enable a specimen to beremoved and/or passed through the incision (e.g., the permanent removalof diseased internal anatomy and/or the temporary exteriorization ofportions of the colon to be manipulated outside of the body before beingreturned to inside the body) without the need to remove the sleeve,thereby providing, via the sleeve, a protective layer for the incisionagainst, e.g., contamination via cancer cell seeding or the like. Stillfurther, with the sleeve, the user may selectively increase the size ofthe incision during the course of the surgical procedure (e.g., asurgeon may make an initial relatively small incision—such that thesurgical access port is maintained in the incision without the sleevebeing used—and may later, if the surgeon decides that doing so iswarranted, make a larger incision—such that the surgical access memberis maintained in the incision with the sleeve being present. Thisflexibility may enable a surgeon to minimize the size of the incisionmade during the surgical procedure, as the surgeon may wait to make alarger incision until after he or she has determined, using theinitially smaller incision, to enlarge the incision based on his or herobservations. It also enables the surgeon to utilize the same surgicalaccess member regardless of the size of the incision and regardless ofwhether the surgeon elects to make an initially small incision or tomake an initially larger incision, thereby eliminating the need fordifferent sized surgical access members. It should be noted that theseabove-described benefits are applicable to all of the embodiments setforth herein.

1. (canceled)
 2. A surgical access assembly comprising: a proximal ring positionable against an outer surface of body tissue; a distal ring positionable against an inner surface of body tissue; a membrane having a proximal end and a distal end defining a passage therethrough, the distal end of the membrane coupled to the distal ring and the proximal end of the membrane coupled to the proximal ring, a length of the membrane being selectively adjustable; a sleeve having a proximal end and a distal end defining a channel therethrough, the distal end of the sleeve coupled to the distal ring and the proximal end positionable proximally of the proximal ring, the channel of the sleeve located in the passage of the membrane; and an access member having proximal and distal ends, the access member positionable in the channel of the sleeve, the access member securable to the sleeve.
 3. The surgical access assembly of claim 2, wherein the access member includes a least one lumen extending therethrough.
 4. The surgical access assembly of claim 2, further comprising a fastening member for securing the access member in the channel of the sleeve.
 5. The surgical access assembly of claim 2, wherein the access member, the sleeve, and the membrane form a fluid-tight seal between the outer surface of body tissue and the inner surface of body tissue.
 6. The surgical access assembly of claim 4, wherein the fastening member is disposed in a pocket located on a surface of the sleeve.
 7. The surgical access assembly of claim 6, wherein the fastening member is configured to be tightened to secure a position of the access member relative to the pocket.
 8. The surgical access assembly of claim 6, wherein the pocket has at least one opening for receiving an end of the fastening member.
 9. The surgical access assembly of claim 2, wherein the proximal ring is configured for repeated eversion to adjust a length of the sleeve.
 10. The surgical access assembly of claim 9, wherein the access member is positionally fixed relative to the sleeve such that repeated eversion of the proximal ring moves the access member relative to the distal ring.
 11. The surgical access assembly of claim 2, wherein repeated eversion of the proximal ring adjusts a length of the sleeve and the length of the membrane.
 12. The surgical access assembly of claim 2, wherein rolling the proximal ring adjusts the length of the membrane so as to provide a retraction force.
 13. The surgical access assembly of claim 7, wherein the fastening member includes a grooved surface and a receiving member that securely engages the grooved surface.
 14. The surgical access assembly of claim 7, wherein the fastening member further includes angled ridges and a pawl, the pawl attached to a release member. 